1215151527 NPI number — MOSER EYES, INC

Table of content: (NPI 1215151527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215151527 NPI number — MOSER EYES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOSER EYES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215151527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 S COLUMBIA RD
Provider Second Line Business Mailing Address:
COLUMBIA MALL, BOX 29
Provider Business Mailing Address City Name:
GRAND FORKS
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58201-6076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-746-4240
Provider Business Mailing Address Fax Number:
701-775-5112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 S COLUMBIA RD
Provider Second Line Business Practice Location Address:
COLUMBIA MALL, BOX 29
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-6076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-746-4240
Provider Business Practice Location Address Fax Number:
701-775-5112
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOSER
Authorized Official First Name:
WADE
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
701-746-4240

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  141143 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8B934ST . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 022965 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 18351 . This is a "SPECTERA" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: MOS 892718 . This is a "VISION SERVICES INC" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: ND 1143 . This is a "EYEMED" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 24377 . This is a "AVESIS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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